Introduction: The aim of the study was to compare adalimumab or golimumab with infliximab in patients with moderately-to-severely active ulcerative colitis (UC).

Material and methods: This paper was prepared according to the PRISMA guidelines. The systematic literature search was performed in PubMed, Embase, and Cochrane Library. No direct head-to-head comparisons for infliximab vs. adalimumab or golimumab were available so an indirect comparison according to the Bucher method was performed after a homogeneity evaluation of the included studies.

Results: Six RCTs were included in the systematic review. An indirect comparison was performed, which revealed that infliximab was more effective in inducing clinical response compared with both doses of adalimumab (160/80 mg or 80/40 mg; p &lt; 0.05), and, in clinical remission, infliximab was more effective than adalimumab (only for a dosage regime of 80/40 mg; p &lt; 0.05). No statistically significant differences in clinical response and clinical remission were observed between infliximab and golimumab in the induction phase. A significant (p &lt; 0.05) advantage only of infliximab compared with adalimumab at doses of 80/40 mg and 80/160 mg was seen in terms of clinical response in the maintenance phase (up to 52&ndash;54 weeks). The indirect comparison revealed that serious adverse events were significantly more frequent among patients treated with a maintenance dose of 100 mg of golimumab compared with those treated with infliximab (p &lt; 0.05).

Conclusions: No significant differences in efficacy in the maintenance phase between infliximab and golimumab or adalimumab were revealed. Infliximab proved to be more effective than adalimumab but of similar efficacy to that of golimumab in the induction phase.

Figure 0001: Study flow diagram showing the results of the search and process of screening and selecting studies for inclusion in the indirect comparison

Mentions:
As described in detail previously [3] the systematic review was conducted and reported according to the methods and recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement [23] and the Cochrane Handbook [24]. The systematic literature review was conducted using the main electronic databases, Medline via PubMed, Embase, and the Cochrane Central Register of Controlled Trials, until 27 November 2014. The key words ulcerative colitis (population) and infliximab or adalimumab or golimumab (intervention) were used to find relevant citations. Only English, French, and German publications were included. The search strategy was presented with the QUOROM diagram (Figure 1). Two reviewers independently conducted the search and selection of studies on the basis of the previously established inclusion criteria. The decision for inclusion was made by consensus to reach the final decision. The Clinical Trials Register (www.clinicaltrials.gov) was searched for unpublished or ongoing trials.

Figure 0001: Study flow diagram showing the results of the search and process of screening and selecting studies for inclusion in the indirect comparison

Mentions:
As described in detail previously [3] the systematic review was conducted and reported according to the methods and recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement [23] and the Cochrane Handbook [24]. The systematic literature review was conducted using the main electronic databases, Medline via PubMed, Embase, and the Cochrane Central Register of Controlled Trials, until 27 November 2014. The key words ulcerative colitis (population) and infliximab or adalimumab or golimumab (intervention) were used to find relevant citations. Only English, French, and German publications were included. The search strategy was presented with the QUOROM diagram (Figure 1). Two reviewers independently conducted the search and selection of studies on the basis of the previously established inclusion criteria. The decision for inclusion was made by consensus to reach the final decision. The Clinical Trials Register (www.clinicaltrials.gov) was searched for unpublished or ongoing trials.

Introduction: The aim of the study was to compare adalimumab or golimumab with infliximab in patients with moderately-to-severely active ulcerative colitis (UC).

Material and methods: This paper was prepared according to the PRISMA guidelines. The systematic literature search was performed in PubMed, Embase, and Cochrane Library. No direct head-to-head comparisons for infliximab vs. adalimumab or golimumab were available so an indirect comparison according to the Bucher method was performed after a homogeneity evaluation of the included studies.

Results: Six RCTs were included in the systematic review. An indirect comparison was performed, which revealed that infliximab was more effective in inducing clinical response compared with both doses of adalimumab (160/80 mg or 80/40 mg; p &lt; 0.05), and, in clinical remission, infliximab was more effective than adalimumab (only for a dosage regime of 80/40 mg; p &lt; 0.05). No statistically significant differences in clinical response and clinical remission were observed between infliximab and golimumab in the induction phase. A significant (p &lt; 0.05) advantage only of infliximab compared with adalimumab at doses of 80/40 mg and 80/160 mg was seen in terms of clinical response in the maintenance phase (up to 52&ndash;54 weeks). The indirect comparison revealed that serious adverse events were significantly more frequent among patients treated with a maintenance dose of 100 mg of golimumab compared with those treated with infliximab (p &lt; 0.05).

Conclusions: No significant differences in efficacy in the maintenance phase between infliximab and golimumab or adalimumab were revealed. Infliximab proved to be more effective than adalimumab but of similar efficacy to that of golimumab in the induction phase.